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Abstract
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"Fishtail deformity" is a rare complication seen in patients who suffered a distal humeral fracture in the early childhood after conservative or surgical fracture treatment. There are only few case reports in the literature on this subject. Based on a case of a 9-year-old patient, who presented himself to our clinic with a dislocated osteochondral lesion "fishtail deformity" and a history of surgical treated transcondylar fracture at the age of four, we want to draw attention to this rare complication and give an overview of the current literature.
Using a case report and a review of the literature, we give an overview on pathogenesis, clinical presentation and treatment options.
We present one case of a young patient who sustained a distal humeral fracture at the age of four. It was treated with closed reduction and K-wire fixation. The patient showed an uneventful course without impairment and full range of motion in the follow-up after K-wire removal. 5 years later, he suffered a slight distortion of the elbow followed by pain, impaired range of motion and a sensation of joint blockage. The imaging showed dislocation of an osteochondral lesion and "fishtail deformity" of the distal humerus. We performed open partial refixation, bone grafting and minced autologous chondral AMIC procedure to address the osteochondral lesion.
"Fishtail deformity" is a rare growing disorder in children with a history of a distal humeral fracture. Patients can complain about pain and impaired range of motion of the elbow up to many years after the first trauma. Some present with osteochondral lesions. It can occur both after non-operative and operative treatment of a distal humeral fracture. It is probably caused by an arrest of the ossification or impaired vascularisation between the humeral capitulum and the humeral trochlea. An observational treatment is recommended if the range of motion is just slightly impaired. An operative treatment should be considered in patients with highly impaired range of motion, pain or joint blockage. Radiological long-term follow-up after distal humeral fractures could be discussed, even in asymptomatic patients, to avoid delayed diagnosis and complications.
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